III.C. Needs Assessment Update

 

Indiana’s 2020 Title V Needs Assessment was transformational for the state health department and our partners. Throughout the process we had nearly 400 partners take our first survey, 200 Hoosiers participate in focus groups, and 5,000 additional people take our final survey statewide in our primary data collection methods. We also partnered with other state agencies, universities, hospitals, non-profits, and more to collect and compile secondary data and surveillance to integrate into our findings. The comprehensive story that emerged grounded our internal teams and external partners with shared goals and allowed us to set strategic priorities for the next five years. After closely looking at the statewide needs assessment data, Indiana has chosen the following priority needs to focus on for the next five years:

 

1. Reduce Preventable Deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates.
2. Reduce Health Disparities and Inequities in internal programs, policies, and practices to improve maternal and child health.
3. Prevent Substance Use including alcohol, tobacco and other drugs among pregnant women and youth.
4. Strengthen Mental, Social, and Emotional Wellbeing through partnerships and programs that build capacity and reduce stigma.
5. Promote Physical Activity through policy improvements and changes to the built environment.
6. Access to high-quality, family-centered, trusted care is available to all Hoosiers.
7. Engage Families and Youth with diverse life experiences to inform and improve MCH services.
8. Ensure Frequent Surveillance, Assessment and Evaluation of data drives funding, programming, and system change.

 

Before operationalizing our new State Action Plan, IDOH felt it was critical to share the findings from the Needs Assessment far and wide. The MCH Programs Director gathered as many people as possible to hear about the findings between August 2020 – April 2021. The results were shared within IDOH on multiple occasions, with IDOH stakeholders and governing boards, at the annual infant mortality conference, with other state agencies, with partners/stakeholders, and within the general MCH population. On top of planned presentations, IDOH presented at meetings by request, expanding our reach even further. Lastly, a recorded presentation, slides, fact sheets, and all findings were posted to IDOH’s public facing website - available for all to use and download.

 

Following the data presentations, IDOH worked to release a new, equitable grant opportunity for Title V community-based funding. It was important to the team that the Request for Application (RFA) process was 1) clearly aligned with the priorities of our new state action plan; 2) identified work that spanned the life course; 3) was accessible to all organizations and 4) was less burdensome and taxing to complete in the midst of a pandemic – increasing access to this funding opportunity across the state. Most of all, IDOH eliminated the rigid structure around this funding opportunity that was previously in place to put the power and expertise into the hands of community partners. IDOH MCH worked to completely reimagine their RFA, ultimately settling on a two-round process. Round one consisted of an application with only four essential questions that was just a few pages long. Round two consisted of a 30-minute pitch presentation and allowed IDOH to have face-to-face conversations with potential subgrantees.

 

The process was going to be a major change for past and current partners, so MCH ensured all upcoming changes were well-communicated with IDOH leadership and with potential applicants up to a year in advance. With our leadership team, it was important to communicate the needs assessment findings, the proposed changes to the RFA process, and prepare them for potential questions from legacy stakeholders. With potential applicants, it was important to explain the changes to the application, ensure they have access to the needs assessment findings, and challenge them to prioritize one to two needs in their community based on their knowledge of the community. To accomplish this, IDOH MCH hosted a webinar to review the funding opportunity, share the recorded presentation, and continued to answer emails and post a frequently asked question document on a weekly basis.

 

The funding opportunity released in March 2021 went better than IDOH MCH ever imagined. With 95 total applications (compared to approximately 20 - 30 in past years) and 50 pitch presentations, MCH selected 36 grantees to carry out and operationalize the 2020 – 2025 State Action Plan. Twenty-nine grantees were funded with Title V and seven were moved to funding through a state grant program aimed at reducing infant mortality.

 

Newly awarded grantees began their work on October 1, 2021. We launched this cycle with an all-grantee meeting in October 2021. During the kickoff meeting, IDOH gave an overview of the Title V MCH Block Grant, reviewed the reporting requirements on custom made templates from our summer interns, and discussed how to invoice for the work being done. After the first quarter, IDOH met with each organization for one-on-one calls in January 2022, learning more about each project and discussing successes and challenges for each grantee. With many newly funded organizations, there were a lot of questions regarding the logistics of the grant. In April 2022, IDOH held a virtual all-grantee meeting – once again linking them to the bigger MCH – sharing resources for HRSA, Title V, AMCHP, the MCH Evidence Center, NICHQ, and more. Grantees shared that this two-hour meeting was one of the best and more informative calls they have ever been a part of – and partners were very engaged even with the difficulties of virtual meetings. Recently, the MCH Title V team met again (one-on-one) with each grantee in July 2022. The calls were used to share resources and offer guidance where needed. Again, grantees have thanked the Department for such a collaborative grant process – affirming our new approach to grants. MCH proudly hosted an in-person, all-grantee meeting in October 2022. A speaker from the office of equity and inclusion for the State was able to present, all grantees received the “Title V Ted Talk” and played Title V trivia, and the day was concluded by breakout groups and partner sharing. We had an overwhelmingly positive response to the day from our grantees. IDOH repeated this process over the last year and will host grantees for an all-person event in October. IDOH teams continue to provide support, technical assistance and training, and resources to invest in the broader public health workforce.

 

The Title V program relies heavily on subgrantees and partners in the non-profit sector and healthcare setting to extend the reach of staff and deliverables. As result of the needs assessment and the subsequent transformation in Indiana’s Title V programming, MCH is working alongside the following 29 grantees to carry out and operationalize the 2020 – 2025 State Action Plan. Below is a brief description of what each grantee has been working on over the past two years:

 

• Alcohol & Addictions Resource Center is implementing Handle with Care (HWC) in Northern Indiana. HWC is a program that supports children exposed to trauma and violence through improved communication and collaboration between law enforcement and school agencies while also helping agencies connect families, schools and communities, to local resources. This is a system change, and AARC is collaborating with schools, fire, police, parks, the mayor’s office, and many other agencies that offer resources to youth and families. They have already built a massive network that will lead to the overall success of this system change. 

 

• The Indiana Alliance of Boys & Girls Clubs is implementing Smart Moves: Emotional Wellness. This program focuses on positive coping strategies that build three cognitive-behavior skills most linked to helping youth avoid negative thought patterns and negative behaviors: self-regulation, impulse control, and stress management. They completed the school year with a high rate of participation by youth across the state and are fostering a club-wide environmental change that promotes emotional wellness.

 

• Clark County Health Department is tackling high rates of unsafe sleep deaths through building a Community Action Team, offering Safe Sleep and CPR classes, hosting community focused events, and offering other supporting services to families. They continue to screen for Adverse Childhood Experiences and Social Determinants of Health, serve uninsured mothers, and engage kinship caregivers.

 

• Columbus Regional Health, Healthy Communities Initiative has created IMPACT - the Infant Mortality Prevention Action Team. IMPACT works collaboratively with local, state, and national organizations, with a passionate focus and urgency, to improve the health and well-being of women and children in our community and service area. They have brought together the entire community and continue to expand their reach through innovative partners, accessible education (including a podcast in Spanish), and engaging youth voices.

 

• Community Dental Clinic is working to promote optimal pediatric oral health through prevention, intervention and education by bringing high-quality, compassionate dental care to the Plain community – consisting of Amish and Mennonite communities of rural northern Indiana. The Community Dental Clinic leads the way in working alongside this community that is often wary of preventive health care. They have built trust in the community and continue to serve more youth through schools and family visits.

 

• Community Health and Wellness Center serves pregnant persons and infants up to one year of age. They support positive birth outcomes, as well as promote optimal health and well-being for both mom and baby. They have really approached their services with a trauma-informed lens, careful to consider mental health, social wellbeing, and economic challenges the families they serve may face in rural Indiana. CHWC has built a huge network of partners across county lines to offer wraparound services to anyone in their care.

 

• Connections, Inc. works alongside youth during probation in Marion, Lake and Wayne counties to implement gun violence prevention and Stop the Bleed training. Stop the Bleed provides teens bleeding control training to allow them to become immediate responders and provide initial trauma care. They have provided valuable training to youth at risk of recidivism and foster youth during a critical time and will continue expanding their reach.

 

• Council for Youth Development Bartholomew County is working across the entire county to support youth and young adults. They now have a youth master plan – which involves many leadership and job opportunities for teens including a Youth Ambassador Program, youth empowerment conference, and internship positions across their community. They are truly creating a culture, vision, and system that supports a young person's ability to exercise power over one's life by being skilled, critically aware, and active in creating positive community change.

 

• Drug & Alcohol Consortium of Allen County aims to strengthen the suicide safety net under youth through providing toolkits, training, and providing peer support to youth having suicide thoughts and attempts. The group has offered resources that can be used statewide and is working closely with schools to provide continued support to prevent youth suicide.

 

• Dunebrook promotes and delivers oral health education to low-income Healthy Families participants and deliver parenting education to expectant/new parents to improve family functioning and harmony to optimize children's mental, social and emotional health. Dunebrook has also developed an oral health training module that can be taught to home visiting providers statewide.

 

• Eclectic Soul VOICES Corporation offers a cross-age, peer mentoring and civic leadership training program for system impacted youth in Indiana. Power and Promise offers youth and their families the resources they need for housing, clothes, school needs, tutoring, poetry, activism, mental health supports, and job supports. They are serving families with very complex needs while also providing a space for youth and young adults to thrive and grow outside of juvenile detention.

 

• Floyd County - Open Door Youth Services is offering support and activities to youth in rural Indiana through their Hopeful Minds and Kids in the Kitchen programming. They also are creating a system of care for school-based mental health and suicide prevention programming to elementary, middle, and high school students.

 

• Four County is working to implement Linking Education and Awareness for Depression and Suicide (LEADS) program for youth. LEADS is a school-based suicide prevention curriculum designed for high schools and educators that links depression awareness and suicide prevention. 

 

• Goodwill Industries of Michiana, Inc. is developing a regional diaper bank in Northern Indiana to collect and distribute free diapers to low-income families experiencing diaper need. They have already demonstrated the need based on the number of families being served and are currently awaiting a decision from The National Diaper Bank on their membership, which would greatly assist them in further growth and expansion.

 

• Harrison County Health Department is offering annual well-women visits, pre-conceptual counseling, prenatal/postpartum care and family planning services to all women in Harrison, Crawford and Washington Counties in Indiana. They are also serving women in Meade County in Kentucky who are uninsured or under-insured regardless of ability to pay. They are currently experiencing an influx of Haitian Creole speakers and are working to provide translation services to this population.

 

• Healthy Communities of Clinton County is implementing their Early Start, Better Finish model that will serve at least 100 women directly through prenatal programming and care, specifically reaching rural, low-income women and Hispanic women, and indirectly serve at least 5,000 women via an awareness campaign, traditional and social media, and events. They offer pregnancy testing, prenatal care, prenatal classes, and parenting classes. HCCC also offers community events and is working to increase their reach into a large Latinx population.

 

• Hoosier Uplands is implementing their Bright Futures for Families program. This program serves as a “BFF” for any pregnant and postpartum woman needing help, advice, or services. The case manager helps navigate needs to ensure a holistic approach to both their pregnancy and the first year of their child's life. They continue to seek further support for transportation and housing in their rural setting without many affordable options.

 

• Indiana University Richard M. Fairbanks School of Public Health, Dept. of Social and Behavioral Sciences continues to implement Mothers on the Rise (MOTR) - aimed at supporting a successful community transition for mothers incarcerated within the Leath Nursery Unit of the Indiana Women's Prison (IWP). They are currently serving women upon discharge to reintegrate and navigate terms of their release, infant needs, maternal needs and more. They have had tremendous success in preventing recidivism for all moms served in MOTR and are still working to find affordable and stable housing for the families they serve.

 

• IU Health Ball Memorial Hospital is creating a HIPPA compliant text-messaging and remote monitoring virtual platform to all obstetrical practices by providing prenatal care and monitoring hypertension among their population. The platform is currently being built and piloted by a small group of pregnant patients. Blood pressure monitoring has been very successful in their pilot phase.

 

• Marion County Commission on Youth, Inc. is embedding a Community Health Worker within an Indianapolis public school system that struggles with chronic absenteeism. The CHW will support families and youth to address the importance of school attendance while also assisting the family to access resources and build social capital.

 

• Marion County Public Health Department is supporting the Healthy Families home visiting program across the county to address racial disparities in infant mortality by focusing specifically on decreasing unsafe sleep-related and accidental strangulation and suffocation in bed deaths within non-Hispanic Black program participants.

 

• Mental Health America of Northwest Indiana is implementing Healthy Beginnings, which provides a holistic, family-driven approach to reduce infant mortality, improve child and family wellness outcomes, and enhance their community’s capacity to meet identified child safety challenges and individualized family needs. They have been successful in building a community action team for their county that brings together key stakeholders to address family needs and prevent infant and child deaths.

 

• One Community One Family is providing Mental Health First Aid, Youth Mental Health First Aid, and QPR suicide prevention trainings to the southwestern part of the state which is very rural and has limited resources. They are also implementing the Parent Café model to support families and foster protective factors among caregivers.

 

• Open Door Adolescent Health Center (ODAHC) is a school-based comprehensive health and mental health clinic that provides free of charge services to Michigan City High School students. ODAHC will promote healthy living by providing school-based primary and preventive health care to medically under-served youth through partnerships that include community medical and mental health providers.

 

• Raphael Health Center is conducting education sessions to discuss best practices to reduce Infant Mortality and gain insight among the non-Hispanic Black population. The groups will combine initiatives to educate and develop peer support as the means to support the reduction of infant mortality and improve the health of women who are pregnant, recently delivered or plan to be pregnant. This neighborhood health clinic serves a lot of pregnant persons, but people are still wary to gather with COVID-19.

 

• Reid Health is building a Centering Pregnancy group. Centering Pregnancy delivers prenatal care in a different way that allows patients to have more time with providers and learn more about pregnancy, the birthing process, and caring for a newborn. Since this is a group setting, there is also the added benefit of connectedness with peers. Reid Health is currently finalizing a location for their group and then will being recruitment.

 

• Ripley County Health Department is offering safe sleep education and materials to parents and caregivers expecting or with a child under the age of one to reduce Infant Mortality in Southeastern Indiana. They have had a lot of success in engaging dads and other caregivers for in-person classes and will continue to expand their parenting classes.

 

• Seasons Counseling of Michiana is providing individual counseling, curriculum-based group counseling, and stigma-reducing education services to students, families, faculty, and staff at area schools and youth-serving agencies. They have continued to see an increased need for more support and are working with graduate level social work students to build a pipeline of providers in adolescent mental health. The Seasons team will continue to expand given the currently high need of mental health services among youth.

 

• YMCA of Greater Indianapolis is working alongside childcare facilities to provide on-site mental health services for families and referrals in nine preschools and are working to support independent home-based childcare. They continue to provide professional development for childcare staff around social-emotional learning, trauma-informed care, ACEs, child abuse and prevention, interactive group games, and more.

 

In addition to these 29 grantees, seven Fetal Infant Mortality Review (FIMR) teams have also applied to receive Title V funding through our Request for Applications process. In order to maximize our Title V funding and extend our reach, the seven FIMR teams were funded through the Safety PIN state fund.

 

As we near the end of two-year contracts for these 29 grantees supported by Title V funding, IDOH is working alongside each partner to understand current need and future work plans. IDOH wants to commit to our community partners with a long-term four-year investment if needed, and we will ultimately decide if we will extend contracts with these partners for two more years. It is likely that most partners will continue to build on their work, strengthening and deepening their reach.

 

Indiana has also proudly shared our model for equitable grant making far and wide. Eden and Kate presented at AMCHP 2022 and has since shared the model both internally and across many states through one-on-one calls. Kate partnered alongside Iowa and Wisconsin to present at AMCHP 2023, and IDOH is still sharing best practices to grant making. IDOH is extremely proud of the change and the results, bringing in new partnerships that have made impactful change in communities across the state.

 

This new grant process and the incredible work done on behalf of our partners around the state continues to demonstrate that this change to Title V programming and funding has paid off. Not only has IDOH built stronger relationships and a stronger public health workforce through our subgrantees, but we have used every relationship forged in the 2020 Needs Assessment to continue building other valuable partnerships over the past year. IDOH continues to unite with other state agencies more than ever before to tackle complex social and behavioral health issues. The Title V program has strengthened partnerships with state agencies such as: Family and Social Services Administration (FSSA) which contains the Division of Mental Health and Addiction (DMHA), First Steps, the Office of Medicaid Policy and Planning (OMPP), the Office of Early Childhood and Out-of-School Learning, and the Division of Family Resources. We have partnered with the Department of Child Services, the Department of Education, the Commission on Improving the Status of Children, and the Indiana Department of Corrections, and local housing authorities in new ways that have led to meaningful connections. Both MCH and CSHCS continue to work strategically across the state agencies to address complex issues: combining skillsets and funding to further our collective impact which benefits the MCH population. Together, IDOH and DMHA have created the first Youth Advisory Board. IDOH, FSSA, and DCS are rapidly expanding My Healthy Baby – on a mission to connect pregnant women to home visiting services. CSHCS, Help Me Grow, and Newborn Screening continue to partner with First Steps on referrals and critical coverage for families with developmental needs. IDOH and DMHA worked together to bring more pediatric mental health services to the state through the Be Happy Program. IDOH and DOC works to support women and their babies who are incarcerated and is reimagining what youth services look like after leaving the DOC. The Children’s Commission is working to address child health and safety for Indiana’s most vulnerable youth. IDOH and the Department of Education are working to share and implement change based on findings from the 2021 Youth Risk Behavior Survey. IDOH and OMPP collaborate on data sharing for Indiana’s Medicaid population. 

 

The Title V program in Indiana also has expanded our federal partnerships. We have regularly engaged with HRSA, the Family and Youth Services Bureau, the CDC, Office of Victims of Crimes, the Office of Women’s Health, and the Office of Population Affairs. The team also collaborates regularly with national partners such as AMCHP, ASTHO, CityMatCH, the national network of perinatal quality collaboratives, AIM, the MCH Workforce Development Center, 2020 Mom, and the Preeclampsia Foundation. IDOH relies on these partnerships for professional development, technical assistance, learning, and growing our networking to learn from other states with common goals. These partnerships will continue to grow and will be used to plan and shape the upcoming needs assessment for 2025.

 

As IDOH looks toward the future, we are keenly aware that the health needs of the population we serve have been largely impacted by the pandemic. We continue to observe a greater need for mental health and substance use services. We know there must be support for more social support and social connectedness, a greater focus on health equity, and will work to catch up on preventative health appointments that were missed in the past two years. The Title V team – including leaders from both MCH and CSHCS – began planning for the upcoming needs assessment starting in August 2022. IDOH intends to do a deeper dive into these topic areas, gain further reach into underserved populations, and gather more qualitative findings for the upcoming year.

 

For the 2025 Needs Assessment, IDOH has contracted with the same external partner, Diehl Consulting Group, to assist with the 2025 needs assessment. A small internal leadership team has been meeting throughout 2023. The first round of secondary data analysis and compilation is complete. A larger team across multiple internal divisions will serve as our steering committee. The official launch of the committee occurred on July 13, 2023, with four consulting team members, 30 staff joining in-person, and 12 staff joining virtually. Our plan is to release a statewide survey this fall that focuses on assets and needs when it comes to healthcare and community health. We will follow the survey with focus groups in 2024 – diving into the needs expressed through the survey. Lastly, we will reassess other secondary data and allow for more time In 2025 to create a new state action plan.

 

IDOH is proud of the work we have accomplished since 2020, even in the midst of a pandemic. The updated grant process, new subgrantees, strengthened partnerships, and staff commitment have continued to help us meet the goals of our 2020 – 2025 State Action Plan. Indiana looks forward to the continued expansion of our work, reach, and impact in the year to come. Most importantly, we look to the continued stories of families around the state and their ever-evolving public health and clinical health needs and how Indiana can best support our Hoosiers.